Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC RUBEOLA ANTIBODY

Facility

$58.00

Service Code	CPT 86765
Hospital Charge Code	900913666
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC RUBEOLA ANTIBODY

Facility

$39.00

Service Code	CPT 86765
Hospital Charge Code	900913666
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC SACRUM AND COCCYX

Facility

$1,037.00

Service Code	CPT 72220 TC
Hospital Charge Code	909001343
Hospital Revenue Code	320
Min. Negotiated Rate	$570.35
Max. Negotiated Rate	$829.60
Rate for Payer: Cash Price	$466.65
Rate for Payer: Cigna of CA HMO/PPO	$829.60
Rate for Payer: Health Smart Auto/Commercial	$622.20
Rate for Payer: LLUH Dept of Risk Management WC	$570.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$777.75

HC SACRUM AND COCCYX

Facility

$1,037.00

Service Code	CPT 72220
Hospital Charge Code	909001343
Hospital Revenue Code	320
Min. Negotiated Rate	$570.35
Max. Negotiated Rate	$777.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$622.20
Rate for Payer: Aetna of CA Government/Medicare	$622.20
Rate for Payer: Cash Price	$466.65
Rate for Payer: Health Smart Auto/Commercial	$622.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$622.20
Rate for Payer: LLUH Dept of Risk Management WC	$570.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$777.75

HC SACRUM AND COCCYX

Facility

$1,037.00

Service Code	CPT 72220
Hospital Charge Code	909001343
Hospital Revenue Code	320
Min. Negotiated Rate	$570.35
Max. Negotiated Rate	$829.60
Rate for Payer: Cash Price	$466.65
Rate for Payer: Cigna of CA HMO/PPO	$829.60
Rate for Payer: Health Smart Auto/Commercial	$622.20
Rate for Payer: LLUH Dept of Risk Management WC	$570.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$777.75

HC SACRUM AND COCCYX

Facility

$1,037.00

Service Code	CPT 72220 TC
Hospital Charge Code	909001343
Hospital Revenue Code	320
Min. Negotiated Rate	$570.35
Max. Negotiated Rate	$777.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$622.20
Rate for Payer: Aetna of CA Government/Medicare	$622.20
Rate for Payer: Cash Price	$466.65
Rate for Payer: Health Smart Auto/Commercial	$622.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$622.20
Rate for Payer: LLUH Dept of Risk Management WC	$570.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$777.75

HC SALICYLATES

Facility

$221.00

Service Code	CPT 80307
Hospital Charge Code	900910366
Hospital Revenue Code	301
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$176.80
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cigna of CA HMO/PPO	$176.80
Rate for Payer: Health Smart Auto/Commercial	$132.60
Rate for Payer: LLUH Dept of Risk Management WC	$121.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$165.75

HC SALICYLATES

Facility

$31.00

Service Code	CPT 80307
Hospital Charge Code	900910366
Hospital Revenue Code	301
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.25

HC SCAPULA

Facility

$1,083.00

Service Code	CPT 73010
Hospital Charge Code	909001479
Hospital Revenue Code	320
Min. Negotiated Rate	$595.65
Max. Negotiated Rate	$812.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$649.80
Rate for Payer: Aetna of CA Government/Medicare	$649.80
Rate for Payer: Cash Price	$487.35
Rate for Payer: Health Smart Auto/Commercial	$649.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$649.80
Rate for Payer: LLUH Dept of Risk Management WC	$595.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$812.25

HC SCAPULA

Facility

$1,083.00

Service Code	CPT 73010
Hospital Charge Code	909001479
Hospital Revenue Code	320
Min. Negotiated Rate	$595.65
Max. Negotiated Rate	$866.40
Rate for Payer: Cash Price	$487.35
Rate for Payer: Cigna of CA HMO/PPO	$866.40
Rate for Payer: Health Smart Auto/Commercial	$649.80
Rate for Payer: LLUH Dept of Risk Management WC	$595.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$812.25

HC SCAPULA

Facility

$1,083.00

Service Code	CPT 73010 TC
Hospital Charge Code	909001479
Hospital Revenue Code	320
Min. Negotiated Rate	$595.65
Max. Negotiated Rate	$866.40
Rate for Payer: Cash Price	$487.35
Rate for Payer: Cigna of CA HMO/PPO	$866.40
Rate for Payer: Health Smart Auto/Commercial	$649.80
Rate for Payer: LLUH Dept of Risk Management WC	$595.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$812.25

HC SCAPULA

Facility

$1,083.00

Service Code	CPT 73010 TC
Hospital Charge Code	909001479
Hospital Revenue Code	320
Min. Negotiated Rate	$595.65
Max. Negotiated Rate	$812.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$649.80
Rate for Payer: Aetna of CA Government/Medicare	$649.80
Rate for Payer: Cash Price	$487.35
Rate for Payer: Health Smart Auto/Commercial	$649.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$649.80
Rate for Payer: LLUH Dept of Risk Management WC	$595.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$812.25

HC SCL 70 AB

Facility

$162.00

Service Code	CPT 86235
Hospital Charge Code	900913525
Hospital Revenue Code	302
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC SCL 70 AB

Facility

$28.00

Service Code	CPT 86235
Hospital Charge Code	900913525
Hospital Revenue Code	302
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

HC SED RATE WESTERGREN MANUAL

Facility

$156.00

Service Code	CPT 85651
Hospital Charge Code	900912022
Hospital Revenue Code	305
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$124.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna of CA HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$117.00

HC SED RATE WESTERGREN MANUAL

Facility

$12.00

Service Code	CPT 85651
Hospital Charge Code	900912022
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SED RATE WESTERGRN AUTOMATED

Facility

$12.00

Service Code	CPT 85652
Hospital Charge Code	900910025
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SED RATE WESTERGRN AUTOMATED

Facility

$132.00

Service Code	CPT 85652
Hospital Charge Code	900910025
Hospital Revenue Code	305
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$105.60
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cigna of CA HMO/PPO	$105.60
Rate for Payer: Health Smart Auto/Commercial	$79.20
Rate for Payer: LLUH Dept of Risk Management WC	$72.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$99.00

HC SEMEN ANALYSIS

Facility

$46.00

Service Code	CPT 89320
Hospital Charge Code	900910151
Hospital Revenue Code	300
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$34.50

HC SEMEN ANALYSIS

Facility

$406.00

Service Code	CPT 89320
Hospital Charge Code	900910151
Hospital Revenue Code	300
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$324.80
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna of CA HMO/PPO	$324.80
Rate for Payer: Health Smart Auto/Commercial	$243.60
Rate for Payer: LLUH Dept of Risk Management WC	$223.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$304.50

HC SENSITIVITY GRAM NEGATIVE MIC

Facility

$320.00

Service Code	CPT 87186
Hospital Charge Code	900912414
Hospital Revenue Code	306
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$256.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of CA HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.00

HC SENSITIVITY GRAM NEGATIVE MIC

Facility

$34.00

Service Code	CPT 87186
Hospital Charge Code	900912414
Hospital Revenue Code	306
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC SENSITIVITY GRAM POSITIVE MIC

Facility

$320.00

Service Code	CPT 87186
Hospital Charge Code	900912412
Hospital Revenue Code	300
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$256.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of CA HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.00

HC SENSITIVITY GRAM POSITIVE MIC

Facility

$34.00

Service Code	CPT 87186
Hospital Charge Code	900912412
Hospital Revenue Code	300
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC SENSITIVITY MIC

Facility

$34.00

Service Code	CPT 87186
Hospital Charge Code	900911558
Hospital Revenue Code	306
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

Know your out-of-pocket cost for care.

All Charges